MEDICARE: DR. JEFFREY K OLSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	14231	TX
2	122300000X	Dentist	7938	CO

General Provider Information

NPI Number	:	1629177167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY K OLSON DDS

Provider Business Mailing Address
First Line	:	9901 VALLEY RANCH PKWY E
Second Line	:	SUITE 1020 LB 28
City	:	IRVING
State	:	TX
Zip	:	75063-4730
Country	:	US
Telephone Number	:	972-869-5966
Fax Number	:	972-869-5972

Provider Business Practice Location Address
First Line	:	9901 VALLEY RANCH PKWY E
Second Line	:	SUITE 1020 LB 28
City	:	IRVING
State	:	TX
Zip	:	75063-4730
Country	:	US
Telephone Number	:	972-869-5966
Fax Number	:	972-869-5972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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